Depression and Bipolar info explaining the latest research in everyday English

10Sep/10Off

Today is World Suicide Day

World Suicide Prevention Day is observed on September 10 each year to promote worldwide action to prevent suicides. Various events and activities are held during this occasion to raise awareness that suicide is a major preventable cause of premature death.

One hand holding another hand.
World Suicide Prevention Day promotes issues such as suicide prevention. This photo is used for illustrative purposes only. It does not imply the attitudes, behaviour or actions of the models used for this photo. ©iStockphoto.com/Valentin Casarsa

Nearly 3000 people on average commit suicide daily, according to the World Health Organization. For every person who completes a suicide, 20 or more may attempt to end their lives. About one million people die by suicide each year. Suicide is a major preventable cause of premature death which is influenced by psycho-social, cultural and environmental risk factors that can be prevented through worldwide responses that address these main risk factors. There is strong evidence indicating that adequate prevention can reduce suicide rates.

World Suicide Prevention Day, which first started in 2003, is annually held on September 10 each year as an IASP initiative. The World Health Organization co-sponsors this event. World Suicide Prevention Day aims to:

  • Raise awareness that suicide is preventable.
  • Improve education about suicide.
  • Spread information about suicide awareness.
  • Decrease stigmatization regarding suicide.

In Australia our annual toll of deaths by suicide is greater than the number of deaths on our roads, yet we only hear about the road toll. Mental health organisations are making slow but steady inroads into the macho culture of Australia and getting politicians and fund holders to realise that reducing the mental health burden of our country is good for our country’s health – fiscal, physical and mental.

There are plenty of places to go if you think you or someone you know might be in need of help to cope with anxiety, depression of suicidal thoughts. Try any of these:

  • Lifeline Australia – tel 13 11 14
  • Kids Helpline - 1800 55 1800
  • Suicide Line (only in Victoria, Australia) – 1300 651 251
  • SANE Australia – 1800 18 SANE (7263)

1Sep/10Off

A review of findings from the world’s largest study of Bipolar Disorder

The Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) ran from 1998 to 2005, with over 4,000 sufferers of Bipolar Disorder (BD) taking part in various trials and assessments over a two-year period.

Researchers were looking at how BD progresses through a person's life, how related it is to other psychiatric disorders, and how related it is to suicidality.

It found that few treatments alone were successful in treating BD, however psycho-social interventions (such as Cognitive Behaviour Therapy) and psycho-education interventions combined with mood stabilizers showed the most positive results.

BD was also shown to be strongly related to substance abuse and smoking, both of which affected the success or otherwise of chemical and psychological treatments.

Interestingly, paroxetine or bupropion were shown to be no more effective than a placebo in achieving sustained recovery (in this instance, determined as eight weeks of 'stable' behavior). So, too, were lamotrigine, risperidone, and inositol found to deliver minimal positive effects.

To the vexed, 'hidden', taboo subject of suicide -- the 'S' word not spoken of by the media (although thankfully that is slowly changing, at least in Australia). Suicidality persists with BD, even when treatment outcomes are good. The biggest predictor of suicidality being previous attempts.

The authors' conclusions
The authors of this review paper note seven contributions of the STEP-BD program:

1. Antidepressants remain poorly effective in treating BD;

2. BD is particularly disabling (tell me about it), and frequently doesn't respond to medications;

3. BD does respond modestly to intensive psycho-social interventions;

4. Other psychiatric disorders are common and destabilizing, yet anxiety disorders and smoking are able to be treated and when treated positively impact on BD;

5. An early age on onset of BD usually results in a more severe course of the illness, but rapid-cycling usually diminishes;

6. The sub-syndrome of Depression may be so strong as to mask the manic pole of BD, therefore careful symptom appraisal by psychiatrists is essential;

7. Suicidal thoughts persist in BD sufferers, and a previous attempt is a good indicator of a future event. However, by reducing feelings of 'hopelessness' in particular, there is the possibility of reducing the risk of suicide.

 

Source: Parikh, S.V., LeBlanc, S.R., & Ovanessian, M.M. 2010. Advancing Bipolar Disorder: Key Lessons From the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). The Canadian Journal of Psychiatry, Vol. 55, No 3, p.p. 136-143.

 


Please see our medical disclaimer.

11Jan/10Off

The hardest post I will ever write?

the double helix splits and colours me with strong shades of night and day - and nothing in-between. Image from http://bipolar.hs.columbia.edu/This may be the hardest post I will ever to have write.

In a way, I am ‘coming out’.

No, I am not gay (although my best man at my wedding was; and so was his partner – what are the odds?!).

I have Bipolar Disorder I.

There, I said it. Publicly [phew!].

No, I don’t want pity, nor do I want to be excluded from events because someone with little or no knowledge of mental disease is worried I’ll do something dangerously psychotic (I’m not psychotic, I can assure you).

Here’s what Beyond Blue say about Bipolar Disorder:

Bipolar disorder, which used to be called manic depression, involves both periods of feeling low (depressed) and high (mania). 

Most people experience a range of moods depending on what's happening in their lives. When good things happen, like getting a new job, going on a holiday or falling in love, it's natural to feel happy. On the other hand, when there are difficulties like losing a job or a loved one, having money or family problems, it can make a person feel down. 

However, people with bipolar disorder experience extreme moods that can change regularly and may not relate to what is happening in their lives, although their mood swings may be triggered by certain events. For more information see What puts a person at Risk?

[Sydney’s Black Dog Institute is another excellent resource, as is NIMH]

What happens with me is that I can be delightful and witty and engaging one day, sunk in despair the next, maxing out the credit cards on day three, back into despair on day four, and on and on. At this stage of my just-started treatment there is little of the ‘middle ground’ that the vast majority of the population would call a ‘normal’ day.

I cycle fast through the ups and downs because I have been undiagnosed and therefore untreated for so many decades and my brain now ‘rapid cycles’, which means I could be in a ‘blue funk’ one day and buying flowers for all the women in Adelaide the next.

My emotional palette has hues far richer and more subtly nuanced than the average person could ever possibly believe; the ‘highs’ are intoxicating in their beauty and joy – everything glows with beauty, enthusiasm and positivity, my thought race at twice (if not more) the speed of the common man, I am more creative, more bottom-spankingly brilliant than just about anyone else around me.

If only I could permanently live in that ‘hypo’ state, but alas I can’t. The ‘mini-highs’ mutate into mania – where thoughts run too fast to capture, where irritation starts to become outright anger, where sleep is what ‘mere mortals’ do.

After which, of course, comes the inevitable ‘crash’. As in science, what goes up must come down; the higher the flight, the deeper and longer the trudge through the valley floor.

My depths are soul-wrenching and almost beyond bearance. In fact, sufferers of bipolar disorder have a vastly higher rate of suicide than the ‘common man’. You’re not going to convince me that Albinoni’s famous ‘Adagio’ wasn’t written when the man was sobbing his heart out – you can hear the strings weeping! Similarly with Barber’s Adagio for Strings, Opus 11 – whilst it *is* a tad more optimistic than Albinoni’s heart-tearer, you can ‘feel’ the grief. Well, I can, anyway.

 

image
Image courtesy K&J Investigations

All is not lost

But all is not lost. It is only early days of my diagnosis (finally; I’ve suffered from BP since I was a child, but it’s only recently been diagnosed) so my team and I are still working out the right medications and dosages for me.

The list of creative people who have made an impact on the world whilst still suffering from this dreadful, incurable disease is long, including: Adam Ant, Russell Brand, Michael Costa (Australian politician), Ray Davies (the Kinks), Patty Duke, Carrie Fisher, Stephen Fry, Paul Gascoigne (English footballer), Mel Gibson, Macy Gray, Graham Greene, Linda Hamilton (Terminator movies), Kay Redfield Jamison, Andrew Johns (Aussie rugby player), Kerry Katona, (English television presenter), Vivien Leigh, Jenifer Lewis (US actress), Kristy McNichol (actress), Edvard Munch, Florence Nightingale (yes, *that* Florence Nightingale), Sinéad O'Connor, Ozzy Osbourne, Jane Pauley, Edgar Allan Poe, Charley Pride, Axl Rose, Michael Slater (Australian cricketer), Margaret Trudeau, Jean-Claude Van Damme, Kurt Vonnegut, Brian Wilson

Well, you get the idea. The disease, whilst something that will be with me forever, is not the end of the world. It is manageable and treatable, and I am fortunate to have a great team around me helping me do just that: manage it.

Does it hurt my consultancy work or any job prospects?

Are you kidding me? I’m 51 years of age – job prospects were something one had in one’s 30s! No one hires 50-somethings these days. So the consulting life is probably going to be mine unless someone does something unheard of and hire a 50-something for more than just greeting people as they enter the supermarket.

But the medication and the therapy and the maintenance team I have built up around me means that the ‘average’ person (who didn’t know my past, nor my present condition) would have no clue as to the disease playing ‘hidey’ with what some have laughingly called my ‘brain’.

So why ‘come out’, Lee?

I wanted to be ‘out and proud’, as it were. Having only recently been diagnosed with Bipolar, I wanted to let the world and my friends know that I suffer from a disease, but that I am *not* the disease.

In other words, “Lee Hopkins suffers from Bipolar Disorder, not Lee Hopkins is Bipolar”. Just like diabetes, Bipolar Disorder is manageable, treatable but also incurable. Like a diabetic I have to watch what stimulants I intake (endless coffees, late nights and bucket loads of alcohol are three that will have to go), but in return I get to live a life with far less of the crushing burden of depression, far fewer times when I can turn around and see the ‘black dog’ faithfully padding along just behind me.

Far fewer times, too, when my thoughts race like a shotgun cartridge of pellets let loose in a paint tin on a paint tin shaker at the hardware shop.

So all I ask is that you understand if I leave your party early, just as it’s getting interesting. Or that you understand when takes me a couple of days to respond to your email or voicemail that it’s not a deliberate snub – just my disease telling me to ‘slow down and smell the roses’.

Or that you understand that my wearing by ear buds whilst working at your premises is also not a snub, or me trying to be ‘hip’; it’s just me listening to something soothing to stop the thoughts racing, or else it’s just me listening to something positive to stop a slide down the snake before it gets going.

So there you have it: “Lee Hopkins has Bipolar Disorder.” Just sayin’…


7Sep/09Off

Depression screening in adolescents

Depression screening in adolescents

The Harvard Mental Health Letter is reporting that the US Preventive Services Task Force is recommending that 12-19 year olds get screened for depression.

BUT, they stress, ONLY if there are adequate systems in place for treatment and follow up care. Which I am sure is comforting for those who live in rural and remote, or extremely poor, areas where such services and systems are lacking.

According to the Harvard Mental Health Letter, major depression affects nearly 3% of children younger than 13, and 5.6% of those ages 13 to 18.

They also note that major depression is so disabling, with long-term consequences, and yet most youngsters who are depressed go undiagnosed and untreated. I am sure I am not alone amongst us all in knowing from personal experience how true that is.

It's also interesting to note that the US Task Force recommended NOT screening pre-teens for depression, on the very sound grounds that there is not enough research into how effective screening tools are, nor is there enough research into how effective therapeutic and psychopharmacological treatment programmes are and what longer-term side effects medicines in particular may generate.

Source: U.S. Preventive Services Task Force. "Screening and Treatment for Major Depressive Disorder in Children and Adolescents: U.S. Preventive Services Task Force Recommendation Statement," Pediatrics(April 2009): Vol. 123, No. 4, pp. 1223-28.; cited in Depression screening in adolescents, Harvard Mental Health Letter, September 2009, p.7


Please see our disclaimer.


Technorati : , , , , ,
Del.icio.us : , , , , ,
Ice Rocket : , , , , ,

27Jun/09Off

Antidepressants and suicide

Here’s a statement of the bleedin’ obvious: ‘depression increases the risk of suicide.’

But the research community is divided as to whether one of the extremely unwanted side-effects of second-generation antidepressants is an actual increase the likelihood of suicide, especially in the initial phases of medication, or not.

1Jun/09Off

Diary of a depressive: 1st June 2009

From the floor of a SFO waiting lounge en route to Seattle

And so a new adventure starts – and one wonders if the old ghosts can travel across the Pacific Ocean. I suspect they can.

Already on the way over I have entertained the thoughts of handgun purchase, wondering how easy it might be and what checks I might have to undertake in order to purchase a weapon and ammo.

Is America the ‘wild, wild west’ of folklore, or is firearm legislation something no longer foreign on these soils.

What would my hosts say and think if I took my own life over there as their guest?

Would any kind of farewell, explanatory letter be enough to curtail any sense of guilt they might have?

What would my wife say to my mother?

A foreboding sense of inertia threatens me; I know that I should make full use of my time here to network and set up business and doctoral contacts and opportunities – but just as in Melbourne last December, being away from the comforting warmth of my routines and familiar surroundings may induce an overwhelming desire to hide from the world, retreat into my cage and sleep for an eternity.

But unlike Melbourne there will possibly/probably be people around me with whom I have to interact and engage, thus keeping me from only functioning at a basic level. There may not be much chance to withdraw into my shell – instead I shall have to keep my happy face on and bounce my way through it all.


   

Depression and Bipolar info is using WP-Gravatar